Basic Information
| Provider Information | |||||||||
| NPI: | 1609229574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PASADERA BEHAVIORAL HEALTH NETWORK, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 S 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857134730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206283400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2502 N DODGE BLVD STE 190 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857162675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206283400 | ||||||||
| FaxNumber: | 5206283151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | CANCHOLA | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACTS, COMPLIANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5206283450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | BH-4798 | AZ | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.